New strategy targets most at-risk populations

Kenya has launched an ambitious strategy to fight HIV/AIDS that aims to reduce new infections by at least 50 percent over the next four years and focus more on most at-risk populations (MARPs).



The third Kenya National AIDS Strategic Plan, which runs from 2009/2010 till 2012/2013 and was launched in the capital, Nairobi, on 12 January, also aims to reduce AIDS-related mortality by 25 percent.



"We cannot achieve our target unless we close new taps of HIV infections - this involves putting most at-risk populations at the centre of our HIV programmes and prevention strategies," said Alloys Orago, director of the National AIDS Control Council.



High risk



In Kenya, female and male sex workers, injecting/intravenous drug users, and men who have sex with men (MSM) are considered primary MARPs.



A 2008 Modes of Transmission study in Kenya revealed that commercial sex workers and their clients accounted for 14 percent of new HIV infections, while MSM and prison populations together account for 15 percent of new infections. The study also found that injecting drug users were responsible for 3.8 percent of new infections.



Speaking at the launch, UNAIDS executive director Michél Sidibé highlighted the paradox of the intention to increase HIV programming among MARPS while at the same time criminalizing the activities that put them at an elevated risk of contracting and transmitting HIV.



Criminalization a block



"Criminalization puts most at-risk populations like commercial sex workers, injecting drug users and men who have sex with men in the shadows," he said. "It is difficult to reach groups whose actions are deemed to be at odds with the law."



Sex work, homosexual acts and the use of illicit drugs are all outlawed in Kenya and are punishable by long terms in prison.



"A series of difficult legal issues arises from attempts to programme more directly for the MARPs, and to take these programmes to scale," the plan states. "Programmes have been working with all these groups for many years, but under constraints."

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Other challenges in reaching MARPS include the lack of data on these groups, their marginalization from formal health services and social intolerance towards them.



The Modes of Transmission study recommended that in the "immediate and short term, ways be examined that will improve and hasten provision of services; in the long term, discuss changing policies and laws that criminalize and discriminate against these groups".



Domestic funding a priority



While the plan has been welcomed by many stakeholders in the HIV/AIDS field, there is some concern about the fact that Kenya remains almost completely dependent on external funding for its AIDS programmes. Kenya requires at least US$3.5 billion to successfully implement the new plan.



"We call on the government to put in place measures that will ensure that funding for HIV treatment is generated locally, because this is the only sustainable way to ensure that people who need treatment get it," said Nelson Otuoma, a representative of The National Empowerment Network of People Living with HIV/AIDS in Kenya. "We cannot rely on donors for ever. What happens when donors pull out? We propose special levies to go towards generating money for treatment."



Kenya's HIV national prevalence stands at 7.1 percent; an estimated 166,000 Kenyans become infected with HIV every year, 34,000 of whom are infants.



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